I started reading through some of these and just stopped after a while.
OP you said you needed this job and that's why you were there. If you ended up without a few seekers now and then and a few hypochondriacs for exploratory surgery....you might end up without a job.
I'm not saying to blindly treat pain, but as MANY others have said, the FULL ASSESSMENT would be important to note.
If 10mg of dilaudid isn't helping except to depress CNS, make a call to MD for a change of meds for better pain management. If patient is sleeping, I document "patient resting on bed with eyes closed, HR xx, BP xxx/xx, respirations xx/min, no acute distress noted at this time"...I don't wake someone to reassess pain. I don't. That's my nursing judgement. I think it's a better idea than waking up a patient for a sleeping pill like the nurse who cared for my mother.
Pain IS what the patient says it is, because they are feeling it, even if we aren't seeing it. Take a look at people who get tattoos - some tolerate well, others end up with what looks like a butchered mess because they writhe in pain. Just because someone is stoic does not mean they don't experience pain. Some of it is cultural.
In your first scenario, I would ASSESS the patients rationale for more pain medicine and delaying their discharge. I would inquire regarding how they intend to manage their pain without pain medicine.
In your second scenario, I would ASSESS the type of surgery, health history (as discussed, bone or nerve pain is difficult to manage) and then utilize my critical thinking skills to determine what may be causing 10/10 pain.
Their pain is perceived as a 10/10. Pain IS what they say it is. However my *intervention* is not to blindly give meds without using my CRITICAL THINKING and ASSESSMENT skills to determine if medication administration is indicated or necessary. I think that as a nurse if 30+ years OP, you should know better, as do most of the nurses on this forum have discussed.
Nurses don't just hand out medication without thinking about it. (At least not GOOD nurses) We deserve more credit than that. Just because a doctor writes an order doesn't mean we don't double and triple check before it gets to the patient.
If the MD orders 10mg dilaudid, obviously they are aware of the patients high tolerance level. I would have advised the MD that pain is still 10/10 but I had to arouse the patient via sternal rub and I'm concerned about excessive CNS depression and maybe we could try "insert drug here after ASSESSING patient allergies".
Also, you work in PACU...let me just tell you that PACU nurses can be some of the bigger jerks when it comes to pain. I am EXTREMELY sensitive to anesthesia and am always difficult to arouse after surgery. I literally feel trapped in my body wanting to scream in pain but I am physically unable to form the words. When I wake up and say I have 10/10 pain, I assure you I am not a drug seeker with addiction problems, but that I have been suffering for a while and I am just now able to form the words. Never once has a nurse offered to further assess my pain to determine where or why, I never get additional pain medicine, I don't have an advocate asking the doctor for something more or something different.
ONE time the physician's wife who took a special interest in me came to visit me in PACU and I managed to tell her I was hurting, so she went to her husband and asked for something. The nurse huffed when having to give it and said "do you want me to push it fast too?"
I realize that not all nurses are like this however. Jut like you should realize that even though pain IS what the patient says it is, we look at the big picture and assess further. Pain (and even vital signs like BP and HR/rhythm) requires more assessment and determination before intervention - it's just not all black and white.
